Plastic surgery concept for reconstruction of complex nose defects after tumor excision: case report

The nose is a common site for skin cancer and is considered one of the most dangerous zones due to the aggressiveness of the disease. Nose reconstruction requires comprehensive knowledge in reconstructive surgery as well as special rhinoplasty concepts to restore the underlying framework. In this report, authors present a 40- year- old male patient with biopsy- verified basal cell carcinoma in one side of the nose with an extensive infiltration of all nasal structures as well as spreading into cheek and upper lip area. A multiple step reconstruction procedure was used to restore the extensive facial defect. In the first operation extensive tumor excision was performed to achieve adequate surgical margins, which included partial nose amputation and extensive cheek and upper lip soft tissue excision. A free microvascular anterolateral thigh flap (ALT) from left thigh region was harvested to cover large facial defect. Second surgery was performed one year later where remodeling of nose framework was accomplished including inner lining, cartilaginous structure reconstruction and final soft tissue coverage. The previously applied ALT flap tissue was deepithelialized and relocated over the nasal defect as inverted flap in order to provide inner lining. The nostril was stabilized by using ear cartilage from the helix region. The large soft tissue defect of the nose was covered with a full thickness forehead flap. During the third operation a forehead flap separation was performed and a defined nasal structure was made. Small defects of the nose after resection of a tumor are a common challenge within the daily routine of facial plastic surgery. Defects can be of varying size and depth, which, during the surgery requires switching from simple concept of using local flaps to the concept of total nose framework remodeling using multiple stage approach.